Laços e nós: A comunicação na relação médico- paciente com câncer e dor crônica

Abstract

The high prevalence of chronic pain in patients with cancer, which has been proven to be associated with intense psychological suffering, is frequently not adequately diagnosed and treated. The author undertook a study at the Pain Clinic of the National Cancer Institute in Rio de Janeiro, involving 120 adult patients, where even those who were aware of their cancer diagnosis did not feel sufficiently informed about the disease and the oncologic pain. This situation brought on dissatisfaction with the treatment received and more demands as to results. The study revealed, nevertheless, that the professional s behavior during the consultation could be perceived by the patients as a factor improving or worsening the pain. tese results have raised questions regarding the quality of the interaction between doctors and patients, which were discussed in this paper. In fact, the professional s considerate behavior was many times more valued than the actual suppression of pain. In spite of the inexistence of sufficient investment either in the doctor-patient relationship, or in the education and training related to that issue, the doctor s communication abilities affect directly the level of information of the patient, as well as his satisfaction, beliefs and even results of the treatment. The doctor-patient relationship has changed over time, no longer presenting itself centered on the disease and the doctor, to center itself more on the patient as an integral being, which entails the doctor s recognition that there are expertises other than his own and that his expertise does not constitute the absolute truth that will apply to others. Although welcome, these changes bring about a certain confusion of roles to be played out by doctors and patients. Doctors face difficulties when dealing with certain differences, with the patients subjective complaints, their emotions as well as the doctor s own. If it is expected today, that patients be participative, co-responsible for their treatments and recovery, conscious of their own power, individually and collectively, it is also expected that doctors be studious, wellinformed, experient, sincere, empathic, sensitive, attentive, compassionate, shrewd, well trained, skillful in sharing informations and decisions with patients, understanding what they want, what they don t want, and helping them express their beliefs, preferences and concerns, allocating time enough for this. All these expectations can end in conflicts that may be resolved with an improvement in communication between doctors and patients in an effort from both sides.